Suturing instrument



June 29., 1965 c. FISCHER ETAL SUTURING INSTRUMENT 2 Sheets-Sheet 1Filed Jan. 26, 1962 I: INVENTORS alowa lll hlll lllll .0. Cormack J.\logelF g PATENT AGENT June 29, 1965 c. FISCHER ETAL SUTURING INSTRUMENT2 Sheets-Sheet 2 Filed Jan. 26, 1962 PATENT AGENT i 5 mm I I l 1 l l l Il l I I I I l I l I MW W United States Patent 3,191,842 SUTURINGINSTRUMENT Christopher LLFischer, Belmont, Calif., and Antoni J.

Smialowski, Sidney H. G. Connock, and Isaac J. Vogelfanger, Ottawa,Ontario, Canada, assignors to Canadian Patents and Development Limited,Ottawa, Ontario, Canada Filed Jan. 26, 1962, Ser; No. 168,945 Claims.(Cl. 227-155) This invention relates to a suturing instrument.

It is well recognized that the suturing of blood vessels in the courseof surgical operations should be effected as rapidly as possible inorderto minimize danger to the patient. However, the suturing step is ofdelicate nature and its effectiveness, as wellas the time involved incompleting it, requires highly specialized skill on the part of thesurgeon particularly in respect of 'blood vessels of small diameter.Frequently, access to the severed blood vessel is restricted, therebyrendering the suturing act even more inconvenient and prolonged.

In prior United States Patent No. 2,940,451 a suturing apparatus isdisclosed which renders it possible to conduct the suturing step in amore rapid and convenient manner. v a

An object of the present invention is to provide a suturing instrumentwhich may be employed to conduct a suturing operation in a more rapidand convenient manner and to produce sutures. which will be uniformlysatisfactory and efliective.

The invention will be described with reference to the accompanyingdrawings, in which-- FIGURE 1 is a plan view of an instrument inaccordance with the invention,

FIGURE 2 is aside elevation of the instrument, FIGURE 3 is a sideelevation of one part of the instrument on line 3-3 of FIGURE 1,

FIGURES 4, 5, 6 and 7 are sections on lines 44, 5-5, 6-6 and 7--7,respectively, of FIGURE 2,

FIGURE 8 is a sectional end elevation of the instrument headandillustrating a step in the suturing operation,

' FIGURE 9 is a perspective View of one element of the instrument,

FIGURE 10 is a side elevation, partly in section of a staple-drivingbushing section of the instrument,

FIGURE 11 is anend view of a staple-driving bushing forming partof theinstrument, 7

FIGURE 12 is a side elevation of a staple-driving bushing section,

FIGURE 13 is an elevation of the bushing section shown in FIGURE 12,

FIGURE "14 is a side elevation of an anvil bushing section,

FIGURE 15 is anend view of an anvil bushing,

FIGURE 16 is an enlarged section on line 16-16 of FIGURE 15,

FIGURE 17 is a side elevation of a staple or' clip for use with theinstrument of the invention,-

FIGURE 18 is a plan view of a portion of the instrument with partsremoved for clarity of illustration,

FIGURE 19 is a perspective view of the jaw end portion of one of theassembly arms, and

FIGURE 20 is a plan view of another portion of the instrument with partsremoved for clarity of illustration.

Referring to the drawing, the instrument comprises i a pair ofassociated but readily separable and'connectable parts 1 and 2, part 1being a staple holding and driving assembly and part 2 being a stapleanvil assembly.

The staple holding and driving assembly comprises a pear of pincers-likebushing clamping arms 3 and 4 3,191,842 Patented June 29, 1965 havingrespective jaws 5 and 6 and spaced handles 7 and 8. A flat spring 9 hasopposed portions recessed in handles 7, 8. It will be apparent that thespring 9 urges squeeze them towards each other will separate the armsand jaws against the action of the spring.

Each jaw 5, 6 has an arcuate inner edge portion 10, and a groove 11 insuch inner edge portion.

Arms 3, 4 have respective engageable flanges 12, 13 fixed to the meetingedges thereof. Each arm 3, 4 has a spring strip 14, 15 mounted thereonas by means of mounting plates 16 adjacent the inner ends thereof. Thefree ends of strips 14, 15 each has a jaw 17, 18 overlying jaws 5, 6 andlaterally aligned therewith Each jaw 17, 18 terminates at a planed endedge 19, and has an arcuate inner edge portion 20, and a groove 21 insuch inner edge portion. It will be apparent that each strip 14, 15normally lies flat in engagement with arms 3, 4 and with groove 21 inparallel relation with nates adjacent the jaw ends of arms 3, 4 andstrips 14, 15 and carries at its free end an inwardly directed lug 25which extends between strips 14, 15 and arms 3, 4 and through a notch 26in strips 14, 15. Notch 26 (see FIGURES 1 and 18) has an inclined camsurface ;27. Each lug 25 has, as shown a flange 28 which extends througha slot 29 in arms 3, 4. It will be observed that, in response to a pullexerted on the legs 23, 24 by means of pull 22, the lugs 25 will reactwith the inclined surfaces 27 to swing the jaw ends of strips 14, 15outwardly from jaws 5, 6 and arms 3, 4.

A staple holding and driving bushing 30 is arranged for clamping betweenthe jaws 5, 6 of assembly 1. Such bushing (FIGURES 10, 11) is ofgenerally cylindrical tubular form but is composed of twopart-cylindrical sections 31, 32. The bushing has a radially outwardlydirected flange 33 at one end thereof, an interior wall surface 34 ofsubstantially uniform diameter from end to end of the bushing, and anexterior wall portion 35 adjacent the other end thereof of greaterdiameter than the exterior intermediate wall portion 36. Portion 35 thusforms an annular shoulder 37. Extending through shoulder 37 is aplurality of staple-receiving uniform and uniformly spaced arcuate slots38. The walls of slots 38 are parallel to the axis of the bushing, theinner surfaces 39 thereof being aligned with and forming a continuationof the exterior surface of wall portion 36. Each slot is fully closedthe latter direction thereof, i.e;, it has an outer wall surface 40opposite surface 39 and end wall surfaces 41 joining surfaces 39 and 40.Shoulder 37 is preferably provided with an outwardly directed end flange42 of minor extent compared with flange 33.

Reciprocally mounted on wall portion 36 of bushing 30 is a tubularmember 43 also formed in two partcylindrical sections 45, 46 and havinga sliding fit engagement with wall 36. Member 43 has an outwardlydirected radial flange 47 at its end adjacent flange 33 and a pluralityof axially directed arcuate fingers 48 at its other end. Member 43 has aretracted position definediby engagement-of a shoulder 49 on member 43and a shoulder 50 on bushing 30, in which position flange 47 is inslightly spaced relation to flange 33 and fingers 48 are disposed inslightly entrant relation to the mounts of slots 38, as shown in FIGURE8. It will be apparent that the cross-sectional area of each finger 48is approximately equal to that of each slot 38 whereby the finger has asliding fit engagement with the walls of the slot. It will also beapparent that reciprocation of member 43 in a direction to separateflanges 47 and 33 will cause the fingers 48 to traverse the slots 38.

It will be observed that the bushing and member 43 as a unit may beclamped between jaws 5, 6 and 17, 18. Thus, with the jaws open, they maybe applied to the bushing whereby, on closing movement of the jaws 5, 6and 17, 18 to bring them into engagement, the flanges 33 and 74 willenter grooves 11 and 21, respectively, bushing 30 having its shoulder 50in engagement with shoulder 49 of tubular member 43. The arcuatepositioning of the bushing in the jaws is defined by reception of pins71, carried by jaws 5, 6, in notches 72 in flange 33.

The staple anvil assembly 2 is somewhat similar in general structure toassembly 1 and comprises a pair of pincers-like bushing clamping arms51, 52 having respective jaws 53, 54 and spaced handles 55, 56. A flatspring 57 having portions recessed in handles 55, 56 urges the arms andjaws towards each other. Each jaw 53, 54 has an arcuate inner edgeportion 59, and a groove 60 is in such inner edge portion. Arms 51, 52have respective engageable flanges 61, 62 fixed to the meeting edgesthereof.

A staple anvil bushing 63 is arranged for clamping between the jaws 53,54 of assembly 2. Bushing 63 (FIGURES 14, 15, 16) is of generallycylindrical tubular form but is composed of two part-cylindricalsections 64, 65. The bushing has a radially outwardly directed flange 66at one end thereof, an interior wall surface 67 of substantially uniformdiameter from end to end of the bushing, and a radial outer flange 68-of minor extent compared with flange 66 at the other end thereof. Aplurality of piars of staple-clinching grooves 69 are formed in theflanged end 68 of the bushing. The bottom surfaces of the grooves 69 aresmoothly curved, and such surfaces of, each pair terminate at asubstantially common apex 70. Each such bottom surface, as shown, has arelatively large radius section and a smaller radius section adjacentits inner terminus.

Bushing 63 is arranged to be clamped as a unit between jaws 53, 54 ofassembly 2 flange 66 being received in grooves 60 of the jaws. Theaccurate positioning of the bushing in the jaws is defined by thereception of pins 73, carried by the jaws in notches 74 in flange 66.

Means for releasably and positively locking assemblies 1 and 2 togetherin a convenient manner comprises a projection 75 fixed to flange 62 ofarm 52, flange 61 being appropriately recessed at 76 to receive theprojection in the closed position of arms 51, 52. Projection 75 has arelatively wide groove 77 in the side surface thereof adjoining arm 51,such groove having side walls 78 and 79 inclined towards the jaw end ofthe instrument (see FIGURE 19).

Projection 75 is receivable in mating recesses 80 and 81 in arms 3, 4. Alocking bar 82 is slidably mounted in a recess 83 in the inner surfaceof flange 13 of arm 4, the bar having a handle 84 for imparting slidingmovement thereto. The bar is mounted and retained in the recess by meansof a pin 85 on the flange 13 and a keyhole slot 86 in the bar. Thestroke of the bar is determined at one end by engaging shoulders 87 onflange 13 and 88 on the bar and at the other end by engaging shoulders89 on the flange and 90 on the bar. The bar 82 has anend portion 91complementarily inclined with respect to groove 77 in the projection 75.In the retracted position of the bar 82 as determined by engagement ofshoulders 89, 90, the projection 75 of assembly 2 is receivable inrecesses 80, 81 of assembly 1. Thereafter, sliding movement of bar 82will cause end portion 91 of the bar to traverse the groove 77 andengagement of the inclined edges of portion 91 with the side walls 78,79 of the groove will draw the assemblies towards each other to placeflanges 42, 68 of the bushings 30, 63 in spaced substantially parallelproximity. Recess 81 is slightly shorter than recess 80 to receive thesomewhat narrower outer end of projection 75 (see FIGURE 20).

Assembly 1 is also provided with a positioning and retaining lug 92carried by a block 93 fixed to spring member 9 and receivable in arecess 94 in a block 95 fixed to spring member 57 of assembly 2.

In FIGURE 17, there is illustrated a staple or clip 96 for use inconnection with the instrument described. The staple as shown has a pairof legs 97 and a bridge 98. The ends of the legs are bevelled asindicated at 99.

The staples 96 are made of suitable metal wire. The various parts of theinstrument are made of metal, plastic composition, or combinationsthereof.

A haemostatic clamp 100 is indicated as removably mounted on the outersurface of each assembly 1 and 2. As shown, each clamp has a pin 101receivable in a hole 102, 103 in the assemblies and a second pin 104receivable in a groove 105, 106 in respective blocks 93, 95.

In operation, the assemblies 1 and 2 are separated and have bushings 30and 63 mounted therein, bushing 30 having a supply of staples 96therein, one in each of slots 38 with the base of each staple positionfor engagement by the end of a finger 48 (-see FIGURE 8).

Haemostatic clamps 100 having been previously applied to the severed endportions 107, 108 of the blood vessel, the assemblies 1 and 2 areapplied to such end portions, which are everted over the ends of therespective bushings 30, 63, as shown in FIGURE 8. The everting operationmay be carried out by means of an instrument such as disclosed in UnitedStates Patent 2,940,452, A. J. Smialowski, or United States Patent3,057,355, A. J. Smialowski et al.

The assemblies 1 and 2 are now connected together in the mannerpreviously described to place the bushings in substantially accurateaxial alignment with the blood vessel ends clamped between the ends ofthe bushings, it being understood that the pressure applied to thevessel by the bushings is not such as to cause injury thereto. It willalso be apparent that such pressure is variable in accordance with thelength of stroke of bar 82, and that the instrument can be designed toprovide any desirable maximum extent of such stroke.

With the various elements in position as shown in FIG- URE 8, thesurgeon applies a full pulling stroke to the pull 22. Such a strokeswings spring strips 14, 15 away from arms 3, 4 until flange 47,carrying with it tubular member 43, engages the shoulder 37 of thebushing 30. It will, however, be apparent that, during this axialmovement of member 43, relative to the bushing 30, fingers 48 will drivethe staples 96 through the slots 38 and through the blood vessel ends.As the ends 99 of each staple engage the surfaces of a pair ofdepressions 69, the legs 97 of the staples are folded into clinchedrelation with respect to the vessel.

An important feature of the invention resides in the fact that thestructure described results in uniformly clinched staples with a minimumof injury to the vessel.

= Thus, since the slots 38 are closed, the legs of each staple are inengagement with wall surfaces 39, 40 and 41 of the slot and are thusprevented from being bowed or otherwise deformed as a result of pressurethereon during engagement of the staple ends with the walls ofdepressions 69.

Another important feature of the invention resides in the fact that theextent of the staple-clinching stroke may be positively determined bythe structure of the instrument is thus not subject to variations inpressure applied by the surgeon. It will be obvious that if thestaple-clinching pressure were too great, serious injury to the vesselcould result. The present invention removes any variable human choice ofpressure in the operation. On the contrary, the extent of thestaple-clinching stroke is positively determined by the instrumentstructure itself.

When the staple-clinching stroke has been effected, the instrument isdetached from the vessel by pressing together the handles 7, 8 and 55,56, thus opening jaws 5, 6, 17, 18 and 53, 54. ()pening of the jawsseparates the sections of the bushings 3t), 63 and tubular member 43,and therefore permits removal of the same from the vessel, the clamps100 remaining in place. The suturing operation is then complete withremoval of the clamps 100.

We claim:

1. A suturing instrument comprising a staple-driving assembly, astaple-anvil assembly, each said assembly comprising a pair of swingablyconnected arms, a spring urging said arms towards each other, a handleon each arm for swinging said arms apart, each said arm having a jawmating with the jaw of the other arm, a pair of independent tubularbushings each having two part-cylindrical sections, said jaws having aclosed position defined by clamping engagement with said bushings and anopen position defined by disengagement from said bushings, a first oneof said bushings having an outwardly directed annular flange at one endthereof, a wall portion adjoining the other end thereof of greaterexternal diameter than that of the remaining wall portion thereof andform ing an annular shoulder in opposed relation to said flange, and aplurality of axially directed circurnferentially arrangedstaple-receiving slots extending from said shoulder to said other end ofsaid bushing, the second one of said bushings having a plurality ofpairs of staple-clinching grooves therein, each pair of said groovesbeing axially aligned with one of said slots, a staple-driving tubularmember slidably mounted in said slotted bushing and having a pluralityof axially directed circumferentially arranged staple-engageablefingers, each said finger being disposed in one of said slots and inconstant engagement with the walls of said slot, means releasablysecuring said assemblies together with said bushings in axial alignment,and means carried by said staple-driving assembly for effecting astaple-driving stroke of said tubular member.

2. A suturing instrument as defined in claim 1, said tubular memberhaving a first shoulder engageable with said bushing shoulder and asecond shoulder engageable with said bushing flange to define the limitsof a stroke thereof.

3. A suturing instrument as defined in claim 1, each said slot having aconstant cross-sectional area from end to end thereof approximatelyequal to the cross-sectional area of one of said fingers.

4. A suturing instrument comprising a staple-driving assembly, astaple-anvil assembly, each said assembly comprising a pair of swingablyconnected arms, a spring urging said arms towards each other, a handleon each arm for swinging said arms apart, each said arm having a jawmating with the jaw of the other arm, and a tubular bushing having twopart-cylindrical sections, one of said sections being arranged forreleasable mounting in one of said jaws, one of said bushings having aplurality of axially directed circumferentially arrangedstaple-receiving slots, the other of said bushings having a plurality ofpairs of staple-clinching grooves therein, each pair of said groovesbeing axially aligned with one of said slots, a staple-driving tubularmember slidably mounted in said slotted bushing, said tubular member andsaid slotted bushing having interengageable shoulders defining thelimits of a stroke thereof, means releasably securing the saidassemblies together with said bushings in axial alignment, and meanscarried by said staple-driving assembly for eifecting a staple-drivingstroke of said tubular member comprising a pair of spring strips eachhaving a jaw embracing said tubular member, each said strip beingmounted on one of said arms of said staple-driving as sembly and havinga cam surface engageable to swing said strip away from said arm, and apull slidably mounted on said arms of said staple-driving assembly andhaving a pair of legs, each said leg having a cam engageable with one ofsaid cam surfaces.

5. A suturing instrument comprising a staple-driving assembly, astaple-anvil assembly, each said assembly comprising a pair of swingablyconnected arms, a spring urging said arms towards each other, a handleon each arm for swinging said arms apart, each said arm having a jawmating with the jaw of the other arm, and a tubular bushing having twopart-cylindrical sections, one of said sections being arranged forreleasable mounting in one of said jaws, one of said bushings having aplurality of axially directed circumferentially arrangedstaple-receiving slots, the other of said bushings having a plurality ofpairs of staple-clinching grooves therein, each pair of said groovesbeing axially aligned with one of said slots, a staple-driving tubularmember slidably mounted in said slotted bushing, said tubular member andsaid slotted bushing having interengageable shoulders defining thelimits of a stroke thereof, means releasably securing the saidassemblies together with said bushings in axial alignment, and meanscarried by said staple-driving assembly for effecting a staple-drivingstroke of said tubular member comprising a pair of spring strips eachhaving a first end fixed to one of said arms of said staple-drivingassembly, a second end swingable away from said arm, and a jaw on saidsecond end embracing said tubular member, and means for swinging saidstrips away from said arms, comprising a member slidably mounted on saidarms of said staple-driving assembly and engaging said strips.

References Cited by the Examiner UNITED STATES PATENTS 2,965,900 12/60Inkouchi 1-349 X GRANVlLLE Y. CUSTER, JR., Primary Examiner.

1. A SUTURING INSTRUMENT COMPRISING A STAPLE-DRIVING ASSEMBLY, ASTAPE-ANVIL ASSEMBLY, EACH SAID ASSEMBLY COMPRISING A PAIR OF SWINGABLYCONNECTED ARMS, A SPRING URGING SAID ARMS TOWARDS EACH OTHER, A HANDLEON EACH ARM FOR SWINGING SAID ARMS APART, EACH SAID ARM HAVING A JAWMATING WITH THE JAW OF THE OTHER ARM, A PAIR OF INDEPENDENT TUBULARBUSHINGS EACH HAVING TWO PART-CYLINDRICAL SECTIONS, SAID JAWS HAVING ACLOSED POSITION DEFINED BY CLAMPING ENGAGEMENT WITH SAID BUSHINGS AND ANOPEN POSITION DEFINED BY DISENGAGEMENT FROM SAID BUSHINGS, A FIRST ONEOF SAID BUSHINGS HAVING AN OUTWARDLY DIRECTED ANNULAR FLANGE AT ONE ENDTHEREOF, A WALL PORTION ADJOINING THE OTHER END THEREOF OF GREATEREXTERNAL DIAMETER THAN THAT OF THE REMAINING WALL PORTION THEREOF ANDFORMING AN ANNULAR SHOULDER IN OPPOSED RELATION TO SAID FLANGE, AND APLURALITY OF AXIALLY DIRECTED CIRCUMFERENTIALLY ARRANGEDSTAPLE-RECEIVING SLOTS EXTENDING FROM SAID SHOULDER TO SAID OTHER END OFSAID BUSHING, THE SECOND ONE OF SAID BUSHINGS HAVING A PLURALITY OFPAIRS OF STAPLE-CLINCHING GROOVES THEREIN, EACH PAIR OF SAID GROOVESBEING AXIALLY ALIGNED WITH ONE OF SAID SLOTS, A STAPLE-DRIVING TUBULARMEMBER SLIDABLY MOUNTED IN SAID SLOTTED BUSHING AND HAVING A PLURALITYOF AXIALLY DIRECTED CIRCUMFERENTIALLY ARRANGED STAPLE-ENGAGEABLEFINGERS, EACH SAID FINGER BEING DISPOSED IN ONE OF SAID SLOTS AND INCONSTANT ENGAGEMENT WITH THE WALLS OF SAID SLOT, MEANS RELEASABLYSECURING SAID ASSEMBLIES TOGETHER WITH SAID BUSHINGS IN AXIAL ALIGNMENT,AND MEANS CARRIED BY SAID STAPLE-DRIVING ASSEMBLY FOR EFFECTING ASTAPLE-DRIVING STROKE OF SAID TUBULAR MEMBER.